Potentials, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

C1489 Issued in OR

Legal business name

POTENTIALS, LLC

Practice address

100 39TH St Pier 39
Astoria, OR 97103-2499

Phone

(503) 325-2398

Fax

(503) 325-5932

NPI assigned

Sep 21, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Dana S Dedolph, MA, LPC

Title

Director/Therapist

Phone

(503) 325-2398

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190332800000",
    "number": "1710173802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 39TH ST PIER 39",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971032499",
            "telephone_number": "503-325-2398",
            "fax_number": "503-325-5932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 39TH ST PIER 39",
            "city": "ASTORIA",
            "state": "OR",
            "postal_code": "971032499",
            "telephone_number": "503-325-2398",
            "fax_number": "503-325-5932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTENTIALS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2007-09-21",
        "status": "A",
        "authorized_official_last_name": "DEDOLPH",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DIRECTOR/THERAPIST",
        "authorized_official_telephone_number": "503-325-2398",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA, LPC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "OR",
            "license": "C1489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mekaylia Haili Pishion
• Stephanie Maria Poe, MA, QMHP
• Polly Ann Pope, LPC
• Victoria L Porter
• Portland Vamc
• Michele Powell, CRNP
• Steven J Powell, MSW,LCSW,LLC
• Katelyn Powers, O.D.
• Wynne Elizabeth Preston, LCSW
• Carol Sue Prichard, M.A., LPC

• Community/Behavioral Health Agency in Astoria, OR
• Providers in Astoria, OR by specialty
• Community/Behavioral Health Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.